title: Extensive neurological recovery from a complete spinal cord injury: a case report and hypothesis on the role of cortical plasticity.
abstract: Neurological recovery in patients with severe spinal cord injury (SCI) is extremely rare. We have identified a patient with chronic cervical traumatic SCI, who suffered a complete loss of motor and sensory function below the injury for 6 weeks after the injury, but experienced a progressive neurological recovery that continued for 17 years. The extent of the patient's recovery from the severe trauma-induced paralysis is rare and remarkable. A detailed study of this patient using diffusion tensor imaging (DTI), magnetization transfer imaging (MTI), and resting state fMRI (rs-fMRI) revealed structural and functional changes in the central nervous system that may be associated with the neurological recovery. Sixty-two percent cervical cord white matter atrophy was observed. DTI-derived quantities, more sensitive to axons, demonstrated focal changes, while MTI-derived quantity, more sensitive to myelin, showed a diffuse change. No significant cortical structural changes were observed, while rs-fMRI revealed increased brain functional connectivity between sensorimotor and visual networks. The study provides comprehensive description of the structural and functional changes in the patient using advanced MR imaging technique. This multimodal MR imaging study also shows the potential of rs-fMRI to measure the extent of cortical plasticity.
authors.affiliation: Department of Neurology, Johns Hopkins University School of Medicine Baltimore, MD, USA ; International Center for Spinal Cord Injury, Hugo W. Moser Research Institute at Kennedy Krieger, Inc. Baltimore, MD, USA ; F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute Baltimore, MD, USA.
authors.forename: Ann S
authors.initials: AS
authors.lastname: Choe
authors.forename: Visar
authors.initials: V
authors.lastname: Belegu
authors.forename: Shoko
authors.initials: S
authors.lastname: Yoshida
authors.forename: Suresh
authors.initials: S
authors.lastname: Joel
authors.forename: Cristina L
authors.initials: CL
authors.lastname: Sadowsky
authors.forename: Seth A
authors.initials: SA
authors.lastname: Smith
authors.forename: Peter C M
authors.initials: PC
authors.lastname: van Zijl
authors.forename: James J
authors.initials: JJ
authors.lastname: Pekar
authors.forename: John W
authors.initials: JW
authors.lastname: McDonald
keywords: diffusion tensor imaging; magnetization transfer imaging; plasticity; resting state fMRI; spinal cord injury; trauma